Care, bills increase at S.J. jail

Reports details stress on medical facilities related to realignment

FRENCH CAMP - Correctional health care workers at San Joaquin County Jail find themselves jammed with patients, the result of more chronically ill inmates coming from realignment, according to a study looking at the effect of the shift of inmates from prisons to jails.

FRENCH CAMP - Correctional health care workers at San Joaquin County Jail find themselves jammed with patients, the result of more chronically ill inmates coming from realignment, according to a study looking at the effect of the shift of inmates from prisons to jails.

And the inmates' health care is costing the county more than expected.

The newer wave of inmates are staying at the jail longer, requiring longer-term care at the jail, according to a county evaluation report on the first year of public safety realignment, a state law that shifted responsibility of certain felons from the state to local corrections.

"In reality, the jail is not equipped for long-term housing of inmates," the report said.

San Joaquin County Sheriff Steve Moore said, however, it's not that the jail isn't "equipped" to handle the influx, rather jail facilities aren't "designed" for long-term use.

When the jail was built, it was designed for pre-trial individuals waiting for their cases to be resolved in court and, for those sentenced on misdemeanor charges, typically carrying at most one-year sentences that eventually were reduced to about nine months, Moore said.

The state, in an effort to reduce its prison population, shifted some inmates from prisons to jails beginning last year under AB109. And jail bookings also consist of state parolees arrested on parole violations, who in the past would have been sent back to prison.

The rise in medical services at the jail corresponds with AB109 jail bookings, which grew higher than expected, from 162 in the first month of realignment to 730 during September.

These bookings represented a 21 percent increase in new patients because jail medical staff is required by law to perform health assessments on every inmate.

"We knew we would have an increase in the number, and we expected them to have chronic illnesses," said Ken Cohen, director of health care services at the county. But it's the level of longer-term care that caught medical staff off guard.

Cohen cited that one inmate recently accrued $18,000 in medical expenses in one month.

Correctional staff reported that AB109 inmates "are sicker than those in the general population," according to the report.

"The inmates that are seen are more demanding and seem to arrive with a sense of entitlement that connects with the services they once may have received at the state level," the report said.

Cohen said medical staff had to adjust to the level provided at state prisons, because before realignment inmates cycled out of the jail system faster and didn't require those services.

Medical services at the jail have been expanded to management of illnesses such as heart disease, hepatitis and AIDS. Regular health maintenance, such as mammograms, physicals, immunizations and dental work, are part of the longer-term care.

The County Correctional Health Care department's budget was boosted by $450,000 in the current fiscal year to handle realignment medical care.

The correctional health department has launched several clinics to address chronic illnesses, including a pain clinic, a diabetic clinic and an anticoagulation therapy clinic.

On-site clinics saw 2,282 inmates in from October 2011 to September 2012, and 26 percent of them were AB109 patients.

AB109 patients made up 30 percent of the 693 patients seen by the dental clinic.

Hospital costs totaled $530,200 during the first year, and $105,600 of it was for hospital care of realignment inmates.

Prescription costs were $740,208, of which $180,408 was used for realignment inmates.

"We've not had any catastrophic cases, but, yes, it's concerning," Cohen said, adding that a good portion of the AB109 inmates are older than the previous jail population.

Much of the impact on health services comes from those convicted of felony offenses deemed by the state as "non-serious, non-sexual or non-violent." Prior to realignment, those offenders would have landed in state prisons.

Incarceration sentences for those offenses can run up to three years at the county jail, although local judges are splitting AB109 sentences between jail, alternative incarceration and probation community supervision. Still, terms are longer than in the past - usually more than one year.

"It is a concern because we're responsible for these people," Moore said. At this point, he said, "We're managing the number pretty well."

Moore expects that the realignment jail population should start leveling off in six to eight months when "non-serious, non-sexual or non-violent" sentences begin expiring.

"It is a situation that is important and clearly needs to be monitored," Moore said. "And we will continue to do that."